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Citation: Abel, Emily K., "Hospitalizing Maria Germani," in Bad Mothers: The Politics of Blame in Twentieth-Century America," edited by Molly Ladd- Taylor and Lauri Umansky, New York University Press, 1998, pp.58-66.
©. 1998 by New York University
"Bad" Mothers ~~
The Politics of Blame in Twentieth-Century America
Molly Ladd- Taylor and Lauri Umansky
New York University Press
NEW YORK AND LONDON
NEW YORK UNIVERSITY PRESS New York and London
Copyright © 1998 by New York University
Chapter 6 from Don't Blame Mother: Mending the Mother-Daughter Relationship, by Paula J. Caplan. Copyright © 1989 by Paula J. Caplan. Reprinted by permission of HarperCollins Publishers, Inc.
Chapter 9 © 1997 by Betty Jean Lifton
Chapter 10 from Barren in the Promised Land, by Elaine Tyler May.
Copyright © 1995 by Elaine Tyler May. Reprinted by permission of Basic Books, a division of HarperCollins Publishers, Inc.
Chapter 15 from Newsweek, July 25, 1938, © 1938 by Newsweek, Inc.
All rights reserved. Reprinted by permission.
Chapter 17 reprinted by permission of Price Stern Sloan, Inc., a division of The Putnam Berkeley Group, from How to Be a Jewish Mother, by Dan Greenburg. Copyright © 1964, 1975 by Dan Greenburg.
Chapter 18 © 1965 by Lyn Tornabene
Chapter 19 Reprinted by permission of The Free Press, a division of Simon and Schuster, from Suddenly: The American Idea Abroad and at Home, 1986-1990, by George F. Will. Copyright © 1990 by The Washington Post Company.
Chapter 20 from The Nation, March 26, 1990. Copyright © 1990 by The Nation. Reprinted by permission.
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Library of Congress Cataloging-in-Publication Data
"Bad" mothers: the politics of blame in twentieth-century America / edited by Molly Ladd-Taylor and Lauri Umansky.
ISBN 0-8147-5119-9 (cloth: acid-free paper). - ISBN 0-8147-5120-2 (pbk. : acid-free paper)
1. Mothers-United States-History. 2. Mothers-United StatesPublic opinion-History. 3. Blame- Social aspects- United StatesHistory. I. Ladd- Taylor, Molly, 1955- II. Umansky, Lauri, 1959- . HQ759·B218 1997
306.874'3' 0973--dc21 97-21142
New York University Press books are printed on acid-free paper, and their binding materials are chosen for strength and durability.
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Hospitalizing Maria Germani
Emily K. Abel
During the early twentieth century, a mother could be declared unfit if she did not comply with medical regimes. Fearsome diseases such as cholera, typhoid fever, and smallpox, which had attained epidemic proportions decades earlier, were virtually eliminated after the turn of the century, and other common killers, including rickets, syphilis, and dysentery, lost much of their menace. The conviction that the credit belonged to medical science gave urgency to the task of spreading its benefits throughout society and increased skepticism about women's traditional healing practices. 1
In 1918, the New York Charity Organization Society (COS) engaged in an eight-month conflict with an Italian immigrant couple about the care of their twelve-year-old daughter.i COS workers viewed the couple's opposition to the girl's hospitalization as a form of child neglect.' The case illustrates the burden that the growing faith in medicine could place on immigrant mothers, who lived and worked in unhealthy environments but were blamed when children fell ill.
The COS first visited the Germani household on January 25.4 The family consisted of a musician, his wife, and their six children. Mr. Germani was considered "a rather better class of Neapolitan man," but he lacked work, and the family could not make ends meet. Attention soon focused on the oldest child, Maria, who was ill. The COS suspected tuberculosis. It is easy to forget the terror that scourge inspired eighty years ago. A chronic disease, tuberculosis inflicted years of disability on its victims; it also produced more fatalities than any other causer' Although the disease affected the entire population during the nineteenth century, after 1900 it was concentrated among poor people, especially immigrants and people of color,"
Tuberculosis control was a top priority of the New York City Depart-
Hospitalizing Maria Germani 59
rnent of Health and the city's private charities. At a time when many cities had only fledgling health departments, New York boasted a remarkable array of services, offering curative medicine as well as prevention. The Department of Health launched one of the first major health education campaigns and provided free diagnosis and treatment." The COS supported the department's program by encouraging clients to get tuberculosis examinations, follow medical advice, attend tuberculosis clinics, and enter hospitals and sanatoria. Charity workers considered women responsible for both protecting family members from contagion and ensuring that the sick received appropriate medical services.
At first, the Germanis did not object to the COS's plans for their daughter. They agreed to have Maria's sputum tested, and on March 7 a Department of Health physician diagnosed tuberculosis. The COS's next recommendation provoked more resistance. The COS learned that the doctor considered Maria "a hospital case" and believed that "the sooner she was rushed to the hospital, the better." The doctor's desire to place Maria in a hospital rather than a sanatorium suggests that he considered her case very advanced and recovery unlikely. The Department of Health tried to reserve places at its sanatorium in the Catskill Mountains for people with early stages of disease, who could be "restorj ed] to permanent usefulness in the community." 8 The chief medical officer, Hermann M. Biggs, believed, according to his biographer C.-E. A. Winslow, that "[tjhere were individuals-whose lives were so worthless to the community that it would be an unpardonable waste of public funds to give them the benefit of sanatorium care." 9 City hospitals segregated "hopeless" sufferers from the rest of society but provided little treatment. The subsequent struggle over Maria's hospitalization partly expressed a conflict about the meaning of her life. To health officials and charity workers, she was primarily a carrier of disease; to her family, however, she was a unique and precious child.
The struggle also reveals the invisibility and powerlessness of immigrant mothers. Mrs. Germani spoke little English, and although the COS may have relied on a child or a neighbor to translate (as it did in similar situations), we can assume that the charity workers and Mrs. Germani had at least some difficulty communicating. Nevertheless, the COS interacted primarily with the mother and directed much of the blame for Maria's condition at her.
According to the report of the charity worker who came to take Maria to the hospital, the girl "cried and absolutely refused to go. The mother
60 E MIL Y K. ABE L
was perfectly willing to have her taken and felt it was the best place for her, but because Maria carried on so she felt it would be better to wait until Mr. Germani came home." Given patterns of male domination in many poor and immigrant households, Mrs. Germani may have been reluctant to make a major decision without her husband. But she also may have been adopting the strategy of many other COS clients, verbally agreeing with advice she had no intention of following in order to avoid a direct confrontation. COS clients feared hospital placement. Most had heard horror stories about the poor quality of care in city facilities. Parents also worried about their own loneliness and their children's homesickness. Immigrants with limited English were especially likely to assume that they would be unable to communicate with hospital staff about their children.
On the morning of March 8, Mr. Germani told a charity worker that he had decided not to send Maria to the hospital. Instead, he would take her to the home of his sister, who lived with her husband in an eightroom house on two acres of land in New Jersey. There Maria not only would be isolated from the other children but also would get the fresh air and rich diet believed to have therapeutic value. Mr. Germani also stated that he had taken Maria to a Brooklyn doctor, who had confirmed the diagnosis but consented to the father's plan.
Mr. Germani did not mention his wife's input into those decisions. He may simply have omitted her role, but it is more likely that he viewed himself as solely responsible for determining Maria's care. Significantly, Maria's aunts-Mr. Germani's sisters-appear to have played a large role in the girl's treatment. One assumed the care of Maria in New Jersey. Later, another tried to intervene with the COS on the Germanis' behalf. The aunts also appear to have provided financial help to the Germani household. Mrs. Germani's dependence on her husband's siblings made her especially vulnerable to their judgments of her.
Mr. Germani's decision to send his daughter to New Jersey prompted the COS to report the case to the Society for the Prevention of Cruelty to Children (SPCC), requesting it to find a way to take Maria "by force" to the hospital. Although the COS stressed the importance of persuading clients to accept medical advice, the organization frequently resorted to compulsion. The Department of Health had permitted the forcible detention of tubercular patients since 1901, and the COS did not hesitate to mobilize state power when it failed to obtain voluntary compliance with requests for hospitalization.
Hospitalizing Maria Germani 61
The response of the SPCC in Maria's case must have disappointed the COS. On March 29 the SPCC reported that it could take no action simply on the grounds of the girl's transfer to her aunt's home in New Jersey. A COS charity worker who visited the girl in New Jersey confirmed that she was "getting along very well"; she had "gained weight" and had "plenty of fresh milk and eggs and good care." Nevertheless, the COS remained suspicious of the parents, warning them that the SPCC would be alerted if Maria returned to the city.
Maria did return. On July 9, a COS worker visiting the Germanis after the birth of a baby found Maria at home and her health still poor. She looked "pale and worn" and was dressed in "a heavy white sweater." Mrs. Germani insisted that her own doctor considered Maria "fine" and that she wore the sweater only because she had just returned from the park. The report for July 22 read,
Maria was sitting in a large rocking chair, propped by a big pillow. Her mother said she had just come in from the park (which seemed very doubtful). Maria looks sick and weak and has a very loose cough. She coughs frequently. [The charity worker] asked if Maria might go with her to the doctor's the next time she called, or if the mother would prefer having the doctor call at the house. Mrs. Germani would much prefer the latter and wants an Italian doctor.
This exchange can be interpreted in several ways. Mrs. Germani and the charity worker may, of course, have disagreed about the state of Maria's health. It also is possible that the mother stressed Maria's recovery in order to discourage further COS intervention in her case. Concealment is a common form of resistance to medical surveillance.l? and COS clients frequently claimed that even gravely ill family members were "fine" or "getting better" or "had recovered." Finally, the COS worker may have emphasized Mrs. Germani's statements because they reinforced the prevailing stereotype that immigrant mothers were ignorant and indifferent to their children's well-being. For her part, Mrs. Germani's insistence that Maria be seen in her own home by an Italian doctor underlines the mother's determination to keep medical decision making under family control.
The COS informed the spec of Maria's return, but it again refused to intervene, noting that Maria was going back to New Jersey and that "the mother has promised to cooperate with the SPCc." Although the SPCC,
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like the COS, defined children's care as the mother's responsibility, Mrs. Germani's promise of cooperation made her an acceptable mother, not such a "bad" one as it might appear.
The COS's own investigation confirmed that Maria received good care in New Jersey. On August 15, a charity worker found her "sitting in the back yard under a grape arbor." The case worker described the aunt as "a nice looking woman with a very kind, good face," who seemed "very fond of Maria and cannot do enough for her." Some New York relatives who were visiting were "nice refined people and all so interested in and concerned about Maria." The house was "out in the country where you can see the fields and woods for miles and miles. It is a very lovely spot for Maria if the air is dry enough." Although Maria refused the special food prepared for her, the relatives promised to work harder at persuasion.
On September 23, the case took a dramatic turn. Maria was found at home by a truant officer and was hospitalized by court order against her family's wishes. Although the COS earlier had urged the Germanis to institutionalize Maria, the family turned to that agency for assistance. According to the charity worker's notes, Mrs. Cappetti, one of Mr. Germani's sisters living in New York,
called at the office in a great state of excitement. She said that Maria and her mother had been to court this morning and the judge had ordered that Maria be placed in a hospital. She was taken to the Reception Hospital. The family feel very badly about this and fear the child will grieve herself to death because she is separated from her family. Mrs. Cappetti said her sister in [New Jersey] is willing to keep Maria and they feel that the child has been getting the proper care there and has shown improvement. Mrs. Cappetti takes her regularly to see [the doctor in Brooklyn]. Mrs. Cappetti explained that Maria had come into the city to go to see the doctor .... The truant officer called and found Maria at home. Mrs. Germani probably was not able to explain fully to the officer that Maria was not living at home and he, seeing her there among so many children, no doubt thought the best place for her would be in a hospital. Mr. Germani is very much worried about it and asked Mrs. Cappetti to call and see if the COS could help get the child discharged from the hospital. Mrs. Cap petti was told that the Society would do what they could in the matter.
The Germani family faulted Maria's mother for the disaster. When the charity worker visited the Germani home the following morning, Mrs. Germani "implied that her husband and his family blamed her for Maria's
Hospitalizing Maria Germani 63
commitment." Nevertheless, she had been powerless to prevent it. She had assumed that the officer who came to take her to court was from the school and wanted Maria examined. Her language difficulties had even more drastic consequences in court. The case file continued,
As [Mrs. Germani] cannot speak or understand the English language very well, she did not comprehend all that was going on in the court room. She tried to explain to the Judge that Maria did not live at home and that she was under a doctor's care, but no one seemed to pay any heed to her remarks. When they got into the automobile, she thought they were going to take Maria to the hospital for an examination, but when they arrived there she was told that the child would have to remain.
Maria was transferred to Metropolitan Hospital. Operated by the Department of Public Welfare on the site of the old almshouse on Blackwell's Island, this facility aroused more hostility than any other city hospital. The COS was well aware of its deplorable conditions. In 1911, the COS Committee on the Prevention of Tuberculosis castigated the city for the hospital's "disgraceful" overcrowding. Beds "regularly lined" the halls; many patients were forced to sleep on mattresses on the floor. 11 Two years later, a client who left the hospital "because he could not stand the place" vividly described his experience in a letter to the cos. The bedding he received had been used by other patients without having been washed or even aired.P
Not surprisingly, Maria was miserable in the hospital, begged to be discharged, and steadily deteriorated. In early October a charity worker found her "sitting on a rocking chair all bundled up in her sweater with the saddest and most forlorn look on her face." Mrs. Germani tried to protect her daughter, pointing to Maria's special sensitivities, which made a hospital stay especially intolerable. Unlike her siblings, the girl never expressed her feelings directly but "all the time cries inside." Mrs. Germani feared Maria would "grieve herself to death" if compelled to stay. She also expressed concern about her husband, who took many days off from his new job at a bakery and occasionally threatened suicide. In October, when the 1918 flu epidemic struck New York and city officials placed Metropolitan Hospital under quarantine, both parents became frantic with worry.
Charity workers from the COS tried to allay the Germanis' fears by contacting the hospital administrators to obtain information about Maria. In other ways, however, the cos remained impervious to the parents'
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concerns. Although various relatives beseeched the COS to work for Maria's release, the organization stonewalled. It continually promised to appeal to influential people on Maria's behalf but then used interviews with those same people to explain why Maria should remain in the hospital. As the family grew increasingly irate at the COS for its failure to act, charity workers turned the blame back on the parents, claiming that if they «had done as they promised to do and had not brought Maria home with them all this trouble would have been avoided." A hospital nurse similarly held the parents responsible, arguing that the girl might have recovered had the parents allowed her to enter the hospital sooner.
As the weeks passed, Maria's condition continued to worsen. By the middle of October, she had stopped eating. "I think it is a sin to have a sick child suffer the way she is," wrote one of Maria's cousins on November 8. Maria died in the hospital eight days later, nearly two months after her admission.
By deflecting blame to the parents, the COS absolved itself of responsibility for Maria's death. The agency portrayed the Germanis as ignorant and indifferent, although its own records suggest otherwise. The parents took Maria to the doctor regularly and placed her in the home of a relative who could provide the fresh air and special diet recommended by the Department of Health. The conflict between the parents and the COS centered not on whether Maria should receive medical attention but on what that attention should consist of and, even more, on who should control it. To the COS and the Department of Health, Maria was primarily a source of infection who should be permanently segregated from both other family members and the rest of society. To the parents, however, Maria's life had unique value. They directed their attention toward promoting her recovery, which they believed could occur only within her family.
The parents' focus on the importance of family connection elicited little sympathy. Today, it is fashionable for both government officials and social service workers to adopt the rhetoric of family love and attachment. But in 1918, the Germanis' use of the language of emotion and family intimacy appears to have reinforced their reputation for irrationality and poor parenting.
The case record also reveals the chasm between the responsibility attributed to the mother and her ultimate powerlessness. Mr. Germani appears to have made the major decisions regarding Maria's care, but the welfare agencies held Mrs. Germani accountable for her daughter's health.
Hospitalizing Maria Germani 65
At the same time, Mr. Germani and his sisters blamed Mrs. Germani for Maria's detention, despite the mother's inability to prevent it. Because she spoke little English, she could not communicate adequately with the COS or the truant officer. When she tried to explain in court that Maria did not live at home and was under a doctor's care, "no one seemed to pay any heed to her remarks." Her limited English also led her to misconstrue several events leading to Maria's commitment. Unable to protect her daughter, Mrs. Germani appeared to be a bad mother to her husband and his sisters as well as to the COS. In this case, an immigrant woman's invisibility and powerlessness had tragic consequences for her child.
1. On the way the growing faith in scientific medicine affected popular concern with issues of access and distribution, see Rosemary Stevens, American Medicine and the Public Interest (New Haven: Yale University Press, 1988). Historians now debate the extent to which medical advances contributed to the decline in infectious diseases.
2. The case files of the New York Charity Organization Society are located in the Community Service Society Archives, Rare Book and Manuscript Library, Columbia University, New York. The case discussed in this essay is no. 2072, box 286.
3. On noncompliance with medical advice as a type of child neglect, see Linda Gordon, Heroes of Their Own Lives: The Politics and History of Family Violence (New York: Penguin, 1989), 127-30.
4. Pseudonyms are used in this essay.
5. George Rosen, A History of Public Health, expanded edition (Baltimore:
Johns Hopkins University Press, 1993), 361.
6. Sheila M. Rothman, Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History (New York: Basic Books, 1994), 181.
7. See Daniel M. Fox, "Social Policy and City Politics: Tuberculosis Reporting in New York, 1889-1900," Bulletin of the History of Medicine, 49 (1975): 169-95; Barron H. Lerner, "New York City's Tuberculosis Control Efforts: The Historical Limitations of the 'War on Consumption,' " American Journal of Public Health, 83, no. 5 (May 1993): 758-68; Elizabeth Fee and Evelynn M. Hammonds, "Science, Politics, and the Art of Persuasion: Promoting the New Scientific Medicine in New York City," in Hives of Sickness: Public Health and' Epidemics in New York City, ed. David Rosner (New Brunswick: Rutgers University Press, 1995), 155-96; Rothman, Living in the Shadow of Death.
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8. Hermann M. Biggs, The Administrative Control of Tuberculosis (New York:
New York City Department of Health, 1909), 21.
9. C.-E. A. Winslow, The Life of Hermann Biggs, M.D., D.Sc., LL.D., Physician and Statesman of the Public Health (Philadelphia: Lea and Febiger, 1929), 198.
10. See Michael Bloor and James McIntosh, "Surveillance and Concealment:
A Comparison of Techniques of Client Resistance in Therapeutic Communities and Health Visiting," in Readings in Medical Sociology, ed. Sarah CunninghamBurley and Neil P. McKeganey (London: TavistocklRoutledge, 1990), 159-81.
11. Committee on the Prevention of Tuberculosis of the Charity Organization Society, The Need of Hospitals for New York's Consumptives (New York: Charity Organization Society, 1911), 3.
12. Letter from J. F. to H. M. Johnson, n.d., filed with case no. R966, box 278.
COS staff were so impressed with this letter that they sent copies to numerous city officials.
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